Changes in brain activity associated with cognitive-behavioral exposure therapy for specific phobias: searching for underlying mechanisms

INTRODUCTION

The current evidence collected consistent results about morphological and functional brain changes produced by psychological treatment. Exposure cognitive-behavioral therapy (CBT) is currently the most effective psychological treatment for phobias.

AIMS

To explore the brain activation and self-reported changes in patients with specific phobias to small animals who underwent a CBT exposure program and to prove if the CBT program made phobic patients process feared stimuli similarly to non-phobic persons.

SUBJECTS AND METHODS

The sample consisted of 32 adults, of which 16 (5 males and 11 females; mean age: 38.08) had specific phobia to small animals and 16 (4 males and 12 females; mean age: 21.81) had no phobias. A univariate before-and-after treatment design were used. In addition, the scores of the non-phobic group in self-reports and brain activity were compared with the post-treatment scores of the phobic group.

RESULTS

Data show significant changes in brain activity, and improvements in self-reported measures because of applying CBT to specific phobias. As a highlight, participants showed a greater activation in points of the precuneus after receiving CBT. Also, when compared with non-phobic participants, phobic patients still remain with both fear and defensive responses to phobic stimuli.

CONCLUSIONS

The precuneus seems to be a regulator that reorganizes the processing of phobic stimuli. It can imply as CBT/ exposure also active acceptance, self-awareness, and self-efficacy mechanisms.

TRPM8, ASIC1, and ASIC3 localization and expression in the human oropharynx

BACKGROUND

Oropharyngeal dysphagia (OD) is a prevalent disease with poor prognosis among older people and has no pharmacological treatment. Polymodal sensory receptors like the TRP or ASIC family receptors are potential targets to treat OD. TRPM8 agonists and acidic solutions can improve the swallow response in patients with OD, but little is known about the expression of TRPM8, ASIC1, and ASIC3 in the human oropharynx. The aim of this study was to assess the expression and localization of TRPM8, ASIC1, and ASIC3 in human samples of the oropharynx to lay the basis for new pharmacological treatments for OD.

METHODS

Pathology-free samples from oropharyngeal regions innervated by cranial nerves V, IX, and X were obtained during major ENT surgery and processed to obtain mRNA (20 patients) or to be used in immunohistochemical assays (12 patients). TRPM8, ASIC1, and ASIC3 expression and localization were studied with RT-qPCR and fluorescent immunohistochemistry.

KEY RESULTS

ASIC3 was expressed in the 3 regions studied with similar levels and was localized on sensory fibers innervating the mucosa below the basal lamina of all studied regions. TRPM8 was also co-localized on the sensory fibers innervating the mucosa below the basal lamina of all studied regions. In contrast, ASIC1 was only found in the nerves innervating the tongue muscular fibers.

CONCLUSIONS & INFERENCES

TRPM8 and ASIC3 are found on submucosal sensory nerves in the human oropharynx. Our study lays the basis to use oropharyngeal TRPM8 and ASIC3 receptors as therapeutic targets to develop new active pharmacological treatments for OD patients.

[Ocular paraneoplastic syndrome: cancer-associated retinopathy]

CASE REPORT

We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed.

DISCUSSION

Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour.

[A meta-analytical review of the response by sex to vaccination against hepatitis B in hospital personnel]

OBJECTIVE

To study the influence of gender on the immunogenic response to the hepatitis B vaccine in healthy persons.

DESIGN

Meta-analysis.

SETTING

Primary care: prevention.

PARTICIPANTS

The results published between 1983 and 1991 by several authors dealing with staff in Spanish hospitals were reviewed.

MAIN MEASUREMENTS AND RESULTS

It was observed that the frequency of women's antibody response differed significantly from that of men (chi-squared = 23.35; p < 0.001) with an odds ratio of 2 (95% confidence intervals: 1.64-2.46) and a risk difference of 7.69% (95% CI: 5.2-10.19%).

CONCLUSIONS

The response rate to the hepatitis B vaccine is significantly higher among women than men. However, several factors (e.g. age and weight) may affect these findings. These have not been examined because they were not described in the findings of the preliminary studies.